Address for Correspondence: Dr. Ángel García García, Primary Care Research Unit, La Alamedilla Health Centre, Comuneros 27-31.37003. Salamanca-Spain
E-mail: aglgarcia1@yahoo.es Accepted Date: 20.05.2015
©Copyright 2015 by Turkish Society of Cardiology - Available online at www.anatoljcardiol.com DOI:10.5152/AnatolJCardiol.2015.16958
Editorial Comment
Arterial stiffness in assessment of impaired left atrial function
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Arterial stiffness arises as a result of structural and func-tional changes in the vascular system wall (1). Its measure has gained importance in recent years in the evaluation of vascular risk due to its important correlation with some of the target organ damage that causes hypertension (2, 3) as well as in a non-hypertensive population (4). The ambulatory arterial stiff-ness index (AASI) is very useful for assessing arterial stiffstiff-ness, and it shows a strong correlation with other classical mea-sures such as pulse wave velocity (5, 6). It is common to find left ventricular (LV) dysfunction, which is sometimes associat-ed with left atrial (LA) dysfunction in the absence of LA enlargement or impaired LV relaxation (7), in hypertensive patients, and two-dimensional speckle-tracking echocardiog-raphy (2D-STE) has facilitated its early detection.
In the paper “Ambulatory arterial stiffness index is associ-ated with impaired left atrial mechanical functions in hyperten-sive diabetic patients: A speckle tracking study,” published in this issue of the Anatolian Journal of Cardiology by Kalaycioğlu (8). The authors evaluated the association between arterial stiffness measured with AASI and LA functions using 2D-STE. Results were obtained in a sample of hypertensive diabetic patients who had no history of cardiovascular disease. E (early diastolic mitral inflow velocity)/E’ (early diastolic tissue veloc-ity) and LA volume index were the two parameters of conven-tional echocardiography and 2D-STE which were positively correlated with AASI in the univariate analysis, whereas S-LAs, S-LAe, and SR-LAs (peak LA strain rate during ventricu-lar systole) were negatively correlated, and an independent association was found between AASI and SR-LAs in the mul-tiple linear regression analysis (β=-0.175, p<0.001).
Changes in the vascular system wall are favored by the presence of vascular risk factors, such as hypertension and diabetes mellitus, which could accelerate them. However, it is difficult to determine which of these changes occur first: the functional or structural ones. The enlargement of LA diameter may be an important predictor of endothelial dysfunction and may be considered to be an indicator to assess target organ damage in hypertensive patients (9).
Although speckle-derived strain has been validated in vari-ous circumstances, there is a paucity of data supporting its use in stress echocardiography (10). It was introduced as a post-processing feature of tissue Doppler imaging with veloc-ity data converted to strain and strain rate, and strain imaging information has more recently also been derived from speckle
tracking computer processing (11). Its advantages over tissue Doppler echocardiography include the lack of dependence on the angle of the incident ultrasound beam and the lack of the requirement for specialized imaging because speckle analysis is performed on routine B-mode images. Nevertheless, strain imaging is currently regarded as a research tool.
Although the authors present an interesting topic, the limi-tations of their study only allow finding an association between an increased AASI and an impaired LA function. It will be necessary to conduct further studies with a larger sample and in which arterial stiffness will be measured with another more accurate technique for confirming the results.
Ángel García-García1,2, Luis García-Ortiz1, Manuel A.
Gómez-Marcos1
1Primary Care Research Unit, La Alamedilla, SACYL, IBSAL;
Salamanca-Spain
2Department of Emergency, Clinic Hospital of Salamanca;
Salamanca-Spain
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Dimopoulos S. Heart rate recovery
